Atorvastatin and Posaconazole: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Jul 15, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atorvastatin
Posaconazole
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased atorvastatin exposure, an increased posaconazole exposure and an increased risk of myopathy and rhabdomyolysis
Interaction Deep Dive
Concomitant use of atorvastatin and posaconazole is contraindicated. Although the potential for an interaction between atorvastatin (a CYP3A4 substrate) and posaconazole (a strong CYP3A4 inhibitor) has not been studied, concomitant use of posaconazole and simvastatin (another HMG-CoA reductase inhibitor and CYP3A4 substrate) resulted in significant increases in simvastatin Cmax and AUC. It is feasible that concomitant use of atorvastatin and posaconazole may result in increased atorvastatin plasma concentrations, which may lead to rhabdomyolysis. Concomitant use of posaconazole and atorvastatin (P-gp inhibitor) may also increase posaconazole exposure23. If coadministration is required, monitor all patients for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug 1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of atorvastatin; inhibition of P-gp-mediated efflux transport of posaconazole
Literature reports
1 report — tap to read
a) In clinical trials of healthy volunteers, coadministration of simvastatin and posaconazole resulted in significant increases in simvastatin Cmax and AUC. When a single, 40 mg simvastatin dose was coadministered to subjects receiving posaconazole oral suspension 100 mg once daily for 13 days, the simvastatin mean Cmax and AUC increased by 841% (ratio estimate, 9.41; 90% confidence interval (CI), 7.13 to 12.44) and 931% (ratio estimate, 10.31; 90% CI, 8.4 to 12.67), respectively. Simvastatin acid Cmax and AUC increased by 817% (ratio estimate, 9.17, 90% CI, 7.36 to 11.43) and 634% (ratio estimate, 7.34, 90% CI, 5.82 to 9.25), respectively. When simvastatin was coadministered at the same dose with posaconazole suspension at a dose of 200 mg once daily for 13 days, the simvastatin mean Cmax and AUC increased by 1041% (ratio estimate, 11.41; 90% confidence interval (CI), 7.99 to 16.29) and 960% (ratio estimate, 10.6; 90% CI, 8.63 to 13.02), respectively. Simvastatin acid Cmax and increased by 851% (ratio estimate, 9.51, 90% CI, 8.15 to 11.1) and 748% (ratio estimate, 8.48, 90% CI, 7.04 to 10.23), respectively 23.
Common questions
Can I take Atorvastatin and Posaconazole together?
Increased atorvastatin exposure, an increased posaconazole exposure and an increased risk of myopathy and rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atorvastatin and Posaconazole interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Atorvastatin or Posaconazole need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: ATORVALIQ(R) oral suspension, atorvastatin calcium oral suspension. CMP Pharma Inc (per FDA), Farmville, NC, 2023. DailyMed
- Product Information: NOXAFIL(R) PowderMix delayed-release oral suspension, posaconazole delayed-release oral suspension. Merck Sharp & Dohme LLC (per FDA), Rahway, NJ, 2024. DailyMed
- Product Information: Posaconazole oral delayed-release tablets, posaconazole oral delayed-release tablets. SpecGx LLC (per DailyMed), Webster Groves, MO, 2024. DailyMed
Keep reading about Atorvastatin
Keep reading about Posaconazole
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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